Very Wired Meets Very Tired

By Laurie Gelb, January 24, 2012

We recently moved to a new city, so I set us up with docs at a Very Wired Hospital (we'll call it VWH) that boasts a fully integrated health system and enterprise EHR. My husband sees many specialists, so we've made several visits there already. I was excited that he would finally have a single record.

The yield to date on my attempt at integration: six paper vintage 1980's medical history forms and one woefully inadequate oral interview. One doc's explanation for the manilla madness was "It's for billing [so we can charge for appropriate complexity]." My contributions to these mostly took the form of "see attached" scribbles, referring to my own far superior pt summary sheet, tailored to each specialty...hm, why not specialty-specific intake forms? In the outcomes age, is that really so radical?

I did finally see a specialty-specific form from podiatry. It arrived via snail mail, barely in time-- "We can't use e-mail [to send the form] because it could be hacked." Somehow, though, sending us e-mails about billing detail is OK. It evidently hasn't occurred to VWH yet that PDF forms can be hosted on Web servers.

I could go on and on about VWH (the wall-to-wall paper at every elevator bank is staggering, the appointment and patient tracking process archaic, and yet its reputation allows stratospheric list pricing to plans), but let's focus on EMRs and payor initiatives. It's probably pretty evident that when its flagship providers lag in HIT, no network can realize optimal value from performance management.

BTW, the mail order debacle I wrote about a few months ago culminated in a pharmacy customer service e-mail asking my husband to reply to a general mailbox with his name, DOB, phone and all the incorrect rx he saw on his Web record. We politely declined, for obvious reasons. Somehow the duplication was resolved without this step.

Unfortunately, I very soon thereafter invested 2 weeks of calls in a routine refill that was repeatedly rejected [by the all-knowing, all-seeing adjudication app] for no reason that anyone at the plan, PBM, mail or retail pharmacy could pinpoint. Finally, I was put through to someone at the PBM who was able to determine that the latest PA had no refills appended instead of the 3 that it should have. Do you think that was put on anyone's future checklist? Let me know if the Easter Bunny stops by.

So how does a provider's EMR, however implemented, benefit payors? There could be lower processing costs secondary to more accessible documentation/claims denial support. The EMR should support health outcomes research, disease management, cost management, UR/QA, contracting...so many possibilities.

Many payor networks are building/upgrading their own data warehouses, and, increasingly, aggregating them with other networks.  Plans and providers are sharing via HIEs, pilot projects, academic research and more. In some geographies, public sector HIEs are being superseded by private efforts. Usability on the local level increasingly benefits from...wait for it...local oversight.

In any geography, though, we're drowning in a sea of input screens and datasets that don't reflect real people, workflow or medicine. Transaction and opportunity costs are soaring when you consider the dollars flying out the door due to long and no fixes for often undetected errors, like my husband's pharmacy döppelganger.

What can we control out of all this? Process! 2012 can be the year of common sense, when we give up tweaks to a patchwork, hands-off patient/member/customer flow in favor of [cliché alert] collaboration with those on the front lines (docs, nurses, physician extenders, call center reps, admitting reps, PBX operators and anyone with a finger on the flow) to image and set the break rather than cover it with a cast and good wishes.

Mystery-shop your PBM, clinics, DM vendors, hospitals, plans, call centers, anyone who touches those who pay your salary. Assign the same task to anyone who says, "There's just not that much we can do." If that doesn't work, a few uninterrupted call center hours just might do the trick. Rather than rearrange the deck chairs, as recent tragedy reminds us anew, some people just don't work out in their jobs.